About MOXO Analytics
Modern approaches to ADHD diagnosis and care management consider the disorder to be developmental, cognitive and behavioral. Today, MOXO Analytics is the only clinical system that delivers comprehensive and measurable indices for each of these three aspects of ADHD.
MOXO Analytics is an innovative, online, science-based and clinically validated system. The culmination of years of research now consolidated into an objective decision support tool for the ADHD diagnosis and treatment process.
Performing the MOXO d-CPT (age adjusted) one time only, is enough for the system to generate several detailed reports that provide a uniquely measurable perspective on your patient’s attentiveness profile. Beyond enhancing ADHD diagnosis, MOXO Analytics also provides professionals with a more profound clinical insight into the way individual patients experience the diverse spectrum of ADHD challenges.
Portraying the four attentiveness indices measured by the MOXO ADHD Test, reports deliver actionable data on attention, hyperactivity, impulsivity and timing. Each index is measured quantitatively and relative to the norm (age and gender).
At the click of a button, in addition to the immediate test results (Attentiveness Profile & Performance Graph), you can request an extensive developmental report from MOXO Analytics on your patient’s cognitive performance in ADHD terms. This ground breaking analytic ability is one of the MOXO system’s key advantages, providing clinicians with the means to achieve a more multi-faceted ADHD diagnosis. In sharp contrast to other objective techniques that explore the developmental trajectory of ADHD such as brain imaging, MOXO d-CPT is easily accessible and very easy to administer. All in a single assessment and without the need for repetition or performance of any additional tests.
The Four Attentiveness Indices
MOXO analytics assess four major attentiveness indices: Attention, Timing, Hyperactivity and Impulsiveness
A > Attention
Attention reflects the patient’s ability to correctly evaluate and respond to a stimulus, according to instructions. Patients who experience difficulties in this area have problems paying attention to their environment, or to specific details when required to do so. To an onlooker, a person who appears not to be paying attention can seem somewhat unfocused and detached. However, such patients face intense difficulties in their daily life such as following teachers in class, understanding more complex instructions, keeping track of small changes in their surroundings, avoiding calculation errors and much more.
T > Timing
Timing reflects the patient’s ability to respond correctly within the time-frame allotted for a task. Whilst a person with timing issues may be able to evaluate their environment correctly, they may falter when asked to react in a timely manner to environmental changes. Examples of this are performing tasks requiring a quick and immediate response, as well as staying on schedule. Such tasks might include answering questions under time pressure (even when the material is familiar). Timing problems display similar characteristics to attention problems: A time gap is formed when attempting to perform a task to completion. Since it is difficult to keep track, a gap in the (study) material is formed. As the task continues, this gap increases until eventually; people faced with this type of difficulty lose a sense of continuity along with their ability to stay on top of the task.
I > Impulsiveness
Impulsiveness is the tendency to respond at a point in time which is defined as ‘forbidden’. A person with a tendency to be impulsive might act without considering the situation at hand or the possible outcomes of such behavior. Such conduct can take place even when a person fully understands the more problematic and undesirable outcomes of impulsive behavior. In many cases, impulsiveness might cause people to trigger monitoring processes only after their initial response. Typical features of impulsiveness include difficulty in waiting for a turn or engaging in dangerous behavior without considering the consequences.
H > Hyperactivity
Hyperactivity is difficulty in efficient regulation of motoric output and in refraining from unnecessary or undesirable actions (movement, over talking etc.). In other words, hyperactive behavior will be accompanied by excessive responses that are defined as incorrect and unwanted. Often people who exhibit hyperactivity are aware of the undesirable outcomes of their behavior and yet they still face the difficult challenge of abstaining from such actions.
How the MOXO d-CPT Is Measured
The MOXO d-CPT includes four performance index scores for:
Attention, Timing, Impulsiveness and Hyperactivity.
This index measures the number of correct responses (pressing the space bar in response to a target stimulus) during a stimulus presentation or the void period that follows. The Attention Index allows the assessment of correct responses independently of the response time, therefore providing a pure measure of sustained attention. The difference between the target stimuli number and the number of correct responses gives the number of omission errors.
The Timing index calculates the number of correct responses given only when the target was present on the screen. According to the National Institute of Mental Health (2012), ADHD problems with attention may be expressed in “difficulties in processing information as quickly and accurately as others”. Traditional measurements in d-CPTs usually include Response Time (RT) and RT variability. However, these systems present the stimulus for a very short and fixed period of time; with the response occurring after the stimulus has disappeared. The limitations of such models mean that accurate, but slow participants can be mistakenly diagnosed as inattentive. Often, the same group of patients would respond correctly if allowed more time, whereas patients who truly had attention issues would not respond at all because they are not alert to the target. Therefore, the measurement of RT per-se, addresses only the ability to respond quickly, but not the ability to respond accurately. The MOXO d-CPT introduces a void period after each stimulus with differing lengths of time for each presented element. As a result, the MOXO d- CPT can distinguish between accurate responses performed with “good timing” (during the target presentation) and “bad timing” responses (made after the target has disappeared). Recognizing these two timing aspects separately corresponds to the two different problems of ADHD described by the National Institute of Mental Health 2012: Responding quickly and responding accurately.
The Impulsiveness index is the number of impulsive commissions performed as the initial response to the non-target stimuli. Typically, commission errors are coded in case of an inappropriate response to the target (e.g., pressing a random key). In contrast, the MOXO d-CPT’s Impulsiveness index considers only the first time the space bar is pressed in response to non-target stimulus as impulsive behavior. All other non-inhibited responses are categorized as hyperactive commission.
The Hyperactivity index is the total number of all types of commission responses that were not coded as impulsive responses. Such responses include:
1. Multiple space bar presses of the space bar in response to either target or non-target stimuli, commonly interpreted as a measure of motor hyper-responsivity
2. Random key pressing of any keyboard button other than the space bar
The separation of impulsive commissions from hyperactive commissions allows for the identification of multiple sources of response inhibition problems.
MOXO Distracter Systems
Assessing ADHD Symptoms with Distracter Systems
Standard CPT tests which evaluate ADHD symptoms and specifically the patients’ attention abilities, are performed in laboratory conditions in a quiet room, secluded from distractions. However, researchers believe that such results don’t fully reflect the patient’s conduct and day-to-day behavior in which they are faced with a constant stream of diversions and disturbances to their environment (e.g. Barkley, 1991).
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) defines the diagnostic criteria for ADHD and mentions external stimuli distractibility (“Is often easily distracted by extraneous stimuli”) as a measure of one of ADHD symptoms of inattentiveness. The MOXO test contains a series of distracters that aims to simulate a real-life environment and thus improve the validity of the assessment in relation to everyday life. The effect of distracters was tested on ADHD and control participants.
As you see in the picture below, the gap in performance between the two groups was at its greatest when distractors were introduced (levels 2-7), as opposed to those stages of the test which did not include distractors (levels 1 &8), (see graph below).
MOXO distractors are short animated videos that are irrelevant to the task being performed. They can be visual only, auditory only, or a combination of the two. The test is divided into eight levels and various types of distractors appear throughout the separate levels of the assessment process:
Level 1 > Basic 1: Baseline level, without any distractors
Level 2 > Visual 1: Minor visual distractors
Level 3 > Visual 2: Major visual distractors
Level 4 > Audio 1: Minor auditory distractors
Level 5 > Audio 2: Major auditory distractors
Level 6 > Combo 1: Combination of minor visual and auditory distractors
Level 7 > Combo 2: Combination of major visual and auditory distractors
Level 8 > Basic 2: No distractors (similar to Basic 1)